Provider Demographics
NPI:1376901140
Name:CLARK, ANNETTE ALDRIDGE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:ALDRIDGE
Last Name:CLARK
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 STONECREEK DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-9733
Mailing Address - Country:US
Mailing Address - Phone:540-420-9563
Mailing Address - Fax:
Practice Address - Street 1:2424 ERWIN RD
Practice Address - Street 2:SUITE 504
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3824
Practice Address - Country:US
Practice Address - Phone:919-681-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008320363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics